Benefit plan management

Simplify Benefit Plan Management

A single source of truth allows customization of benefit plans data and auto-generate documents and processes right from quotes to claims processing. The proven platform facilitates data interoperability for Large Groups and TPA/ASO, Commercial and Government, sales and product team, exchange product configuration team, business intelligence team, and Ancillary (Dental, Vision, Pharmacy, STD, LTD, Life) benefit plans.

  • SaaS-based solution purpose-built to automate the end-to-end benefit product lifecycle using a single source of truth.
  • Enables you to house all benefit plans (all LOB and market segments) and non-health product information in one platform.
  • Reduce dependency on multiple systems, risk of penalties, errors, accelerate the sales cycle, and speed-to-market.

Meet the shifting demands of the healthcare payers and TPAs/ASOs with eBenefitSync™.

A leading benefit plan management solution that creates a single end-to-end source of truth and streamlines claims processing.

Highly configurable, modular, and scalable solution

The SaaS-based solution is purpose-built to automate the end-to-end benefit product lifecycle and eliminate the disparate legacy system.

Unified solution developed by healthcare payer professionals

Unlike other cross-industry BPM and PLM solutions, eBenefitSync™ is developed by health plan professionals with deep expertise and profound domain knowledge.

One platform to store and monitor information

eBenefitSync™ enables you to house all benefit plans (all LOB and market segments) and non-health product information in a single source of truth solution.

Turnkey solution for end-to-end process alignment

Right from quotes to claims processing, eBenefitSync™ offers turnkey solutions enabling faster claims processing and speed-to-market.

eBenefitSync™ is named as the 'Sole Leader' in IDC's MarketScape.

2016 Vendor Assessment of the U.S. Health Plan Product/Plan Benefit Configuration Solutions.
IDC MarketScape Chart
Click to enlarge

IDC MarketSpace: The US health plan has announced eBenefitSync™ the ‘Sole Leader’ in the product/plan benefit configuration solutions category.

Learn how using a modular integrated solution, health plans can be future-ready, manage cost, limit risk, and drive growth.

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Why eBenefitSync™?

Work smarter and faster with eBenefitSync™! Enabling health plans and TPAs/ASOs to drive agility by leveraging automation to remove manual congestion, increase operational efficiency, control risk and cost, and accelerate speed-to-market.
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Data Accuracy

Increase data accuracy and consistency up to 80%

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Speed-to-Market

Increase speed-to-market up to 70%

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Data Reusability

Increase data reusability up to 95%

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Claims Recoveries

Decrease claim recoveries up to 70%

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Maintenance

Decrease maintenance up to 60%

Discover how eBenefitSync™ can redefine benefit plan management for healthcare payers and TPAs/ASOs using a single source of truth.

Application Modules

Our benefits plan management solution can be molded according to your business. Select from our integrated modules that suites your business to address your pain points and maximize investments.
Create single source of truth for your plan data

Take control of your data by managing its configuration and use

Establish a single source of truth to automate the end-to-end benefit product lifecycle for Large Group and TPA/ASO health plans, annotate and track changes for regulatory and business communication content, eliminate Excel grids, automate workflows and routing of information between various teams using .Source
Auto-generate documents to meet regulations

Automate document generation and version management processes

Dynamically generate all benefit plan communication documents, including SBCs, SOBs, Contracts, SPDs, Amendments, and Riders from a single source of truth. Enable omnichannel re-use of the language and dynamically generate print-ready documents to meet regulations or share your information on web portals or through print with .Docs
Improve claims management accuracy

Simplify configuration of benefit plans and keep your claims system up-to-date

Configure your benefit plans at one place with intelligent decision support, eliminate repetitive data entry into Core-Admin and other systems, keep your claims system up-to-date, and automate the maintenance of your product configuration with .Claims
Generate a range of documents

Simplify generation of range/bracketed documents with a few clicks

Simplify Large Group and TPA/ASO filings (and for ACA in some states) for SOB/Handbooks/Contracts/EOCs effortlessly. The proven platform captures the ranges of cost shares at the foundation template level and variation in language per some conditions are retrieved from the language repository of that document stored in the Master List. Reuse the data setup and a single source of truth that helps with plan creation using .Filing
Seamlessly share information across the enterprise

Automate the integration of key benefits data and documents into essential systems

Ensure your single source of truth is integrated everywhere across the enterprise. Seamlessly integrate with and from your technology ecosystem via RESTful APIs, Event-based APIs, Data streaming via KAFKA or Event Hub, ETL, batch files using .Integrate

Expose your user-configurable data to standard reporting tools

Ensure your dynamic pristine data is integrated with your Master Data Management investments and is available in real-time to your reporting and business intelligence tools using the relational database format and flexibly captures all types of benefit plans (all LOB and market segments) and non-health product information using .DataMart
Improve speed-to-market with seamless CRM integration

Sell and quote while customizing your benefit plans

Simplify configuration of benefit plans for Large Group and TPA/ASO, Small and Individual Groups with the intelligent decision support for sales, product development, and document generation. Get access to all applicable benefit plans, customize products, seamlessly integrate information within your CRM to create a seamless user experience that increases speed-to-market with .Sales

Case Studies

Leading health plans rely on Simplify Healthcare to work smarter, faster, and optimize operational efficiency. Read about our success stories and learn how we have enabled higher client satisfaction.

Frequently Asked Questions (FAQ's)

Here are the most common, frequently asked questions about implementing end-to-end benefit plan management solution and partnering with Simplify Healthcare.

1. What is benefit plan management?

Health plans and TPAs/ASOs often have thousands of benefits plans and products which they need to manage. New plans are created every year, and existing plans are updated to reflect competitive needs and regulatory requirements. Benefit plans must be submitted to the government for approval by specific deadlines. All plans need to have plan information fed to other systems to support claim payments, member support, group sales, etc. The end-to-end process of managing benefit plans is known as Benefit Plan Management.

2. What are the challenges with traditional benefit plan management processes?

Traditional benefit plan management processes can create many issues that may lead to last-minute rush, significant manual efforts to manage and audit plans, and inaccuracies in data (and the downstream implications). Most healthcare payer TPAs/ASOs maintain their benefit plan data in spreadsheets (aka benefit grids) and documents. During the benefit plan configuration, these get emailed around in a manual, error-prone process that frequently leads to version control problems. The traditional benefits plan management processes can lead to various challenges, such as:

  • Managing version control.
  • Core-Admin systems may require manual keying of the data introducing hard to find and costly errors.
  • Due to version control issues and other factors, critical downstream applications get different versions of benefits information.
  • Manual processes make the benefits plan management slow, labor-intensive, expensive, and creates downstream errors.
  • Benefit teams lose the opportunity to perform more productive tasks such as analyzing the market and consumer trends to offer improved products.

3. Why use the benefit plan management solution?

Our benefits plan management solution, eBenefitSync™, enables health plans and ASOs/TPAs to automate end-to-end benefit plan management processes while improving their operational efficiency by 75%. With its unique capabilities, health plans can create a single source of truth for their benefits data and can generate various benefit documents in a single click. They can also reduce their process backlogs, increase data accuracy, and improve speed-to-market. Having a single source of truth means payers and TPAs can edit data at a single entry point and reflect across the entire benefit plan. This will improve the benefit product turnaround time and help them avoid losses due to incorrect data entries.

4. How can you automate benefit plan configuration and management?

Streamline benefit plan processes with eBenefitSync™ that is ingrained with your existing benefit grids to create a single source of truth for all benefits information. From here, you can configure your plans to comply with guardrails for regulations and business policies via centralized business rules. Its modular approach allows you to implement any or all modules in the order of your most critical pain points and priorities. eBenefitSync™ enables you to house all benefit plans (all LOB and market segments) and non-health product information in a single source of truth solution. This presents a significant strategic advantage to “cross-serve” the groups, members, agents, brokers with products across all business lines.

5. How can a health plan create a single source of truth for their benefit plan management?

Our eBenefitSync™ solution is the only solution in the market built with a full understanding of the benefit plan management process in mind. eBenefitSync™ starts by ingesting your existing benefit grids and documents to create a single source of truth for all benefits information. From here, you can configure your plans to comply with guardrails for regulations and business policies via centralized business rules. With eBenefitSync™, you can collaborate with all stakeholders to manage your plans with the robust workflow capability, including routing, notifications, and a logging function to track all changes. You can then communicate needed information to members with the required documents.

What our customers say.

''Working on a few benefits product development and enhancement projects, I had the opportunity and pleasure of working with Simplify Healthcare. I found the team very enterprising, innovative, and committed, with the way they executed their responsibilities, overcame challenges, explored solutions, and solved problems.''
Benefits Implementation Manager
''What I appreciate about Simplify Healthcare is that they anticipate what will be needed to complete the entire project end-to-end, which minimizes late project life cycle budget increases.''
Benefits Testing Manager
''They help teams to do their jobs better and faster by dummy-proofing various aspects of the product build. eBenefitSync™ enables and encourages consistent product builds, but allows for group-specific benefit requests.''
Former Health Plan CIO

Ready to get started with eBenefitSync™?

Work with industry-leading experts. Our team is ready to answer all your questions. Let’s make smarter health ecosystems together! Schedule a 1:1 demo with us.
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